Cherished Children

Policies- complete, implemented: The operator shall implement and annually review specific written policies, plans and procedures that include, but not necessarily be limited to discipline, when a child is not picked up as planned, multi-hazard and medical emergencies, supervision of children, general operating policies, administrative oversight and personnel policies. The operator shall notify the parent(s), staff and the Office of Early Childhood within five (5) days of changes in these policies, plans and procedures.

Rule 19a-79-3a(d)(2)-(7).

Consultants: An education consultant shall be available to the operator and program staff for advice and support regarding the educational content and practice of the program. A person needs to apply for approval to be an education consultant. Program staff shall not serve as education consultants for programs in which they provide direct care or direct program supervision in a non-consultative role; or in a program with the same operator as a program in which they provide direct care or direct program supervision in a non-consultative role. Specific duties of the education consultant shall include, but not be limited to making, at a minimum, annual site visits to the facility, reviewing daily plans, curriculum documents, and educational policies for the developmental and age appropriate practices, observing program staff interactions, use of materials and equipment, implementation of plans and approaches to classroom management; and providing feedback on documentation review and classroom observations to the director and head teacher. A health consultant shall be available to the operator and program staff for advice regarding the health of the children and the health program. Specific duties of the health consultant shall include, but not be limited to making, at a minimum, quarterly site visits to facilities that serve children three years of age and older; or for group child care homes, facilities that operate no more than three hours per day, or facilities that enroll only school age children, semi-annual site visits. Facilities that are closed during the summer months may omit the summer quarterly visit. Site visits shall be made by the health consultant during customary business hours when the children are present at the facility. Specific duties include, but are not limited to reviewing health and immunization records of children and program staff, reviewing the contents, storage and plan for maintenance of first aid kits, observing the indoor and outdoor environments for health and safety, observing children’s general health and development, observing diaper changing and toileting areas and diaper changing, toileting and hand washing procedures, reviewing the policies, procedures and required documentation for the administration of medications, including petitions for special medication authorizations needed for programs that administer medication, assisting in the review of individual care plans for children with special health care needs or children with disabilities, as needed; and quarterly review of all injury, illness, incident and accident reports. A social service consultant shall be available to the operator and program staff for advice regarding the emotional needs, program staff support and the social service program. A registered dietitian consultant shall be available to the operator and program staff for advice regarding nutrition and food service for those programs that prepare or plan meals. A written plan for consultation services shall be developed, signed annually by the consultant and implemented. Consultative service shall include, but not be limited to an annual review of written policies, plans and procedures that relate to the services provided by the consultant, availability by telecommunication for advice regarding problems, availability, in person, of the consultant to the program, consulting with administration and program staff about specific problems, acting as a resource person to program staff and the parent(s) to include coordinating services and assisting families and program staff in identifying necessary resources, and seeking and supporting the collaboration of multiple consultants serving the program. The activities and observations required by each consultant shall be documented in a consultation log that is kept on file at the facility for two years.

Rule 19a-79-4a(i)(1-2)(H), (F).

Individual care plan- signed by parents/staff: An individual plan of care for any child with special health care needs or disabilities when it is necessary that special care be taken or provided while a child is in attendance shall be developed and implemented with the child’s parent(s) and health care provider and updated, as necessary. The plan shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent and program staff responsible for the care of the child.

Rule 19a-79-5a(a)(2)(E).

Licensed premises-clean, good repair, hazard free-maintenance program: For programs serving children younger than school age, the building, equipment and furnishings shall be maintained in a good state of repair. A maintenance program shall be established that ensures that the interior, exterior and grounds of the building are maintained, kept clean and orderly, free from accumulations of refuse, dampness, stagnant water, dilapidated structures and other health and safety hazards.

Rule 19a-79-7a(c)(2).

Outdoor space: There shall be access to a minimum of seventy-five (75) square feet per child of outdoor space for the number of children using the space at any one time. The outdoor area shall be fenced or protected for safety. Outdoor play equipment shall have a shock absorbing surface, under and around, that shall effectively cushion the fall of a child, except where the child is sitting or standing at ground level. The shock absorbing surface shall be maintained at a depth of at least eight inches, be free of water and not allowed to become compacted. Acceptable shock absorbing surfaces may include mulch, sand, and wood chips. Synthetic material that is less than eight inches in depth, including but not limited to, rubber mats or tiles may be acceptable surfaces provided the operator maintains documentation on the licensed premises that the synthetic material is manufactured for this purpose, installed in accordance with the manufacturer’s specifications and sufficient to cushion the fall of a child. Concrete, asphalt, grass and dirt shall not be considered a shock absorbing surface. The playground shall be free of glass, debris, holes and other hazards. Nuts, bolts and screws shall be tight; and those that protrude shall be covered or protected. Outside equipment shall be anchored for stability when recommended by the manufacturer. Anchors shall be buried below ground level. The operator shall provide documentation to the Office, upon request, by a certified playground safety inspector that newly constructed playgrounds and all newly installed playground equipment that are set in position and anchored in such a way to last indefinitely are designed and installed in accordance with U.S. Consumer Product Safety Commission and the American Society for Testing and Materials Standards. Drinking water shall be available and accessible to children. Outdoor equipment shall be arranged in such a way as to avoid accidents. All play equipment, fences, and structures shall not pose a hazard.

Rule 19a-79-7a(h)(1-9).

Non-Prescription Topical Medications: The written permission of the parent(s) shall be required prior to the administration of the nonprescription topical medication shall be kept on file at the facility for each child administered a nonprescription topical medication. The parent(s) shall be immediately notified of any medication error, and notified of such error in writing not more than seventy two hours after the medication error occurred, and such medication error shall be documented in the child’s record. The medication shall be stored in the original container and shall contain the following information on the container or packaging indicating the individual child’s name; the name of the medication; and directions for the medication’s administration. The medication shall be stored away from food and inaccessible to children. Any unused portion of the medication shall be returned to the parent(s). Any expired medication shall be destroyed in a safe manner or returned to the parent.

Rule 19a-79-9a(a)(2-3).

Non-Prescription Topical Medications: The written permission of the parent(s) shall be required prior to the administration of the nonprescription topical medication shall be kept on file at the facility for each child administered a nonprescription topical medication. The parent(s) shall be immediately notified of any medication error, and notified of such error in writing not more than seventy two hours after the medication error occurred, and such medication error shall be documented in the child�s record. The medication shall be stored in the original container and shall contain the following information on the container or packaging indicating the individual child�s name; the name of the medication; and directions for the medication�s administration. The medication shall be stored away from food and inaccessible to children. Any unused portion of the medication shall be returned to the parent(s). Any expired medication shall be destroyed in a safe manner or returned to the parent.

Rule 19a-79-9a(a)(2-3).

Physical barriers- indoors/outdoors: There shall be a physical barrier separating each group of children under the age of three, indoors and outdoors.

Rule 19a-79-10(c)(4).

Adequate sinks-handwashing-diapering/other use-food prep: In child care centers there shall be a sink with hot and cold running water designated for diaper changing and hand washing of program staff and children. This sink shall be located in the program space. Child care centers which have three program staff for a group of infants or toddlers may use an accessible diaper changing facility if it is immediately adjoining the program area. Separate sinks shall be available for purposes other than hand washing after diaper changing within child care centers. Group child care homes shall have a sink accessible for hand washing other than the sink used for food preparation.

Rule 19a-79-10(d)(1)(A-C).

Linens- Clothing: A supply of linen and emergency clothing shall be available for each child in the child care center or group child care home at all times. All children�s linens shall be washed at least weekly and as needed. Each child�s linens and clothing shall be stored individually. When cribs and cots are shared, all metal, plastic and sealed wood bed frames shall be thoroughly wiped down with a general purpose cleaning agent and linens changed between children.

Rule 19a-79-10(f)(1-4).

Health consultant visits/documentation: The health consultant shall visit the facility according to the following schedule: once a week for children up to twenty-four months of age; once a week if children two to three years of age, attend five hours or more per day; and once a month if children two to three years of age attend less than five hours per day.

Rule 19a-79-10(i)(1)(2A-C).

Written policies and procedures: All child care centers and group child care homes at which designated program staff members will be administering finger stick blood glucose tests shall have written policies and procedures governing the administration of finger stick blood glucose tests to children diagnosed with diabetes mellitus. The policies and procedures shall address at least the following areas: parental responsibilities; program staff training and responsibilities; proper storage, maintenance and disposal of test materials and supplies; record keeping; reporting test results, incidents and emergencies to the child�s parent(s) and the child�s physician, physician assistant or advanced practice registered nurse; and a location where the tests occur that is respectful of the child�s privacy and safety needs. Said policies and procedures shall be available for review by the Office during inspections or upon demand.

Rule 19a-79-13(a)(1).

Staff training � Diabetes: Prior to the administration of finger stick blood glucose tests, the director, head teacher, program staff or group child care home provider shall have completed first aid training. The first aid certificate on file at the facility. Additional training given by a pharmacist, physician, physician assistant, advanced practice registered nurse, registered nurse, certified emergency medical technician or the child�s parent(s) according to written guidelines provided by the child�s physician, physician assistant or advanced practice registered nurse. The additional training shall include, but not be limited to: the proper use, storage and maintenance of the child�s individual monitoring equipment; reading and correctly interpreting test results; and appropriate actions to take when test results fail to fall within specified ranges indicated in the written medication order. The training shall be updated at least every three years when a child with diabetes mellitus who requires finger stick blood glucose testing is present at the facility. Documentation that the director, head teacher, program staff or group child care home provider has been trained to administer finger stick blood glucose tests shall be in writing and kept at the facility for a period of three years for review by the Office. Whenever a child diagnosed with diabetes mellitus who has orders to receive finger stick blood glucose monitoring is enrolled and present at the facility, a director, head teacher, program staff or group child care home provider designated and trained to administer finger stick blood glucose tests shall be present at the facility.

Rule 19a-79-13(b)(1)-(c)(2).

Signed agreement with parent regarding equipment, supplies, materials to be discarded: The operator shall obtain a signed agreement from the child�s parent(s) that the parent(s) agrees to check and maintain the child�s equipment in accordance with manufacturer�s instructions, restocks supplies and removes material to be discarded from the facility on a daily basis. All materials to be discarded shall be kept locked until it is given to the child�s parent(s) for disposal.

Rule 19a-79-13(d)(3).

Authorized prescriber written order: The operator shall keep the following records at the facility as part of the child�s medical record, and shall update them annually or when there is any change in the information. A current, written order signed and dated by the child�s physician, physician assistant or advanced practice registered nurse indicating the child�s name; the diagnosis of diabetes mellitus; the type of blood glucose monitoring test required; the test schedule; the target ranges for test results; specific actions to be taken and carbohydrates to be given when test results fall outside specified ranges; diet requirements and restrictions; (H) Any requirements for monitoring the child�s recreational activities; and conditions requiring immediate notification of the child�s parent(s), emergency contact, the child�s physician, physician assistant or advanced practice registered nurse.

Rule 19a-79-13(e)(1).

Written authorization of parent: An authorization form signed by the child�s parent(s) which includes the following information: the child�s name; the parent(s) name; the parent(s) address; the parent(s) telephone numbers at home and at work; two adult, emergency contact people including names, addresses and telephone numbers; the names of a director, head teacher, program staff or group child care home provider designated to administer finger stick blood glucose tests and provide care to the child during testing; additional comments relative to the care of the child, as needed; the signature of the parent(s); the date the authorization is signed; and the name, address and telephone number of the child�s physician, physician assistant or advanced practice registered nurse.

Rule 19a-79-13(e)(2).

Consultants: An education consultant shall be available to the operator and program staff for advice and support regarding the educational content and practice of the program. A person needs to apply for approval to be an education consultant. Program staff shall not serve as education consultants for programs in which they provide direct care or direct program supervision in a non-consultative role; or in a program with the same operator as a program in which they provide direct care or direct program supervision in a non-consultative role. Specific duties of the education consultant shall include, but not be limited to making, at a minimum, annual site visits to the facility, reviewing daily plans, curriculum documents, and educational policies for the developmental and age appropriate practices, observing program staff interactions, use of materials and equipment, implementation of plans and approaches to classroom management; and providing feedback on documentation review and classroom observations to the director and head teacher. A health consultant shall be available to the operator and program staff for advice regarding the health of the children and the health program. Specific duties of the health consultant shall include, but not be limited to making, at a minimum, quarterly site visits to facilities that serve children three years of age and older; or for group child care homes, facilities that operate no more than three hours per day, or facilities that enroll only school age children, semi-annual site visits. Facilities that are closed during the summer months may omit the summer quarterly visit. Site visits shall be made by the health consultant during customary business hours when the children are present at the facility. Specific duties include, but are not limited to reviewing health and immunization records of children and program staff, reviewing the contents, storage and plan for maintenance of first aid kits, observing the indoor and outdoor environments for health and safety, observing children�s general health and development, observing diaper changing and toileting areas and diaper changing, toileting and hand washing procedures, reviewing the policies, procedures and required documentation for the administration of medications, including petitions for special medication authorizations needed for programs that administer medication, assisting in the review of individual care plans for children with special health care needs or children with disabilities, as needed; and quarterly review of all injury, illness, incident and accident reports. A social service consultant shall be available to the operator and program staff for advice regarding the emotional needs, program staff support and the social service program. A registered dietitian consultant shall be available to the operator and program staff for advice regarding nutrition and food service for those programs that prepare or plan meals. A written plan for consultation services shall be developed, signed annually by the consultant and implemented. Consultative service shall include, but not be limited to an annual review of written policies, plans and procedures that relate to the services provided by the consultant, availability by telecommunication for advice regarding problems, availability, in person, of the consultant to the program, consulting with administration and program staff about specific problems, acting as a resource person to program staff and the parent(s) to include coordinating services and assisting families and program staff in identifying necessary resources, and seeking and supporting the collaboration of multiple consultants serving the program. The activities and observations required by each consultant shall be documented in a consultation log that is kept on file at the facility for two years.

Rule 19a-79-4a(i)(1-2)(H), (F).

Parent Permissions: The operator of a child care center or group child care home is responsible for maintaining on the licensed premises a current record for each child enrolled. A copy of the record shall be available and provided upon request to the Office of Early Childhood, the child’s parent(s) and the local health director. It shall include specific written permission forms signed by the parent(s) authorizing the operator to use the programs emergency policies which shall accompany the child on trips away from the premises, authorizing one responsible person other than the parent(s) who can remove the child from the child care center or group child care home, authorizing any activity away from the premises, and authorizing transportation services.

Rule 19a-79-5a(a)(1)(D)(i-iv).

Individual care plan- signed by parents/staff: An individual plan of care for any child with special health care needs or disabilities when it is necessary that special care be taken or provided while a child is in attendance shall be developed and implemented with the child’s parent(s) and health care provider and updated, as necessary. The plan shall include appropriate care of the child to prevent and respond to a medical or other emergency and shall be signed by the parent and program staff responsible for the care of the child.

Rule 19a-79-5a(a)(2)(E).

Nutritious meals and snacks: A nutritionally adequate meal shall be provided by the child care center or group child care home, or the parent(s) whenever a child remains on the premises for five (5) hours or more. Children who stay on the premises less than five (5) hours shall have a nutritious snack. Children who stay on the premises longer than five (5) but less than eight (8) hours shall have one (1) meal and one (1) nutritious snack. Children who stay on the premises eight (8) hours or more shall have one (1) meal plus two (2) nutritious snacks, or two (2) meals plus one (1) nutritious snack.

Rule 19a-79-6a(a)(2).

Licensed premises-clean, good repair, hazard free-maintenance program: For programs serving children younger than school age, the building, equipment and furnishings shall be maintained in a good state of repair. A maintenance program shall be established that ensures that the interior, exterior and grounds of the building are maintained, kept clean and orderly, free from accumulations of refuse, dampness, stagnant water, dilapidated structures and other health and safety hazards.

Rule 19a-79-7a(c)(2).

Equipment-clean and safe, good repair, non-toxic-sturdy, free from protruding nails, rust: All equipment shall be of such design and material as to be readily cleaned and safe for children. Equipment shall not be colored or covered by any poisonous material. Equipment shall be sturdy, safely constructed and free from protruding nails, rust, toxic material and other hazards.

Rule 19a-79-7a(g)(1).

Indoor climbing play equipment- shock absorbing materials under and around: Indoor play equipment for climbing shall have a shock absorbing surface, under and around, that shall effectively cushion the fall of a child. Carpet is not considered a shock absorbing surface.

Rule 19a-79-7a(g)(6).

Outdoor space: There shall be access to a minimum of seventy-five (75) square feet per child of outdoor space for the number of children using the space at any one time. The outdoor area shall be fenced or protected for safety. Outdoor play equipment shall have a shock absorbing surface, under and around, that shall effectively cushion the fall of a child, except where the child is sitting or standing at ground level. The shock absorbing surface shall be maintained at a depth of at least eight inches, be free of water and not allowed to become compacted. Acceptable shock absorbing surfaces may include mulch, sand, and wood chips. Synthetic material that is less than eight inches in depth, including but not limited to, rubber mats or tiles may be acceptable surfaces provided the operator maintains documentation on the licensed premises that the synthetic material is manufactured for this purpose, installed in accordance with the manufacturer�s specifications and sufficient to cushion the fall of a child. Concrete, asphalt, grass and dirt shall not be considered a shock absorbing surface. The playground shall be free of glass, debris, holes and other hazards. Nuts, bolts and screws shall be tight; and those that protrude shall be covered or protected. Outside equipment shall be anchored for stability when recommended by the manufacturer. Anchors shall be buried below ground level. The operator shall provide documentation to the Office, upon request, by a certified playground safety inspector that newly constructed playgrounds and all newly installed playground equipment that are set in position and anchored in such a way to last indefinitely are designed and installed in accordance with U.S. Consumer Product Safety Commission and the American Society for Testing and Materials Standards. Drinking water shall be available and accessible to children. Outdoor equipment shall be arranged in such a way as to avoid accidents. All play equipment, fences, and structures shall not pose a hazard.

Rule 19a-79-7a(h)(1-9).

Non-Prescription Topical Medications: The written permission of the parent(s) shall be required prior to the administration of the nonprescription topical medication shall be kept on file at the facility for each child administered a nonprescription topical medication. The parent(s) shall be immediately notified of any medication error, and notified of such error in writing not more than seventy two hours after the medication error occurred, and such medication error shall be documented in the child�s record. The medication shall be stored in the original container and shall contain the following information on the container or packaging indicating the individual child�s name; the name of the medication; and directions for the medication�s administration. The medication shall be stored away from food and inaccessible to children. Any unused portion of the medication shall be returned to the parent(s). Any expired medication shall be destroyed in a safe manner or returned to the parent.

Rule 19a-79-9a(a)(2-3).

Staff Health Records: A file shall be kept on the licensed premises for each employee of the child care center or group child care home which shall include an acceptable medical statement and a written report of a negative tuberculin test.

Rule 19a-79-4a(a)(1) and/or 19a-79-4a(a)(2).

Consultant Agreements/Contracts: A written plan for consultation services shall be developed, signed annually by the consultant and implemented. These services shall include an early childhood educational consultant, a health consultant, a dentist or dental hygienist consultant, a social service consultant, and a registered dietitian consultant for those programs that serve meals. Consultative services shall include annual review of written policies, plans and procedures, annual review of education programs, availability by telecommunication for advice regarding problems, availability, in person of the consultant to the program, consulting with administration and staff about specific problems, and acting as a resource person to staff and the parents.

Rule 19a-79-4a(h)(1) and/or 19a-79-4a(h)(2).

Playground Free From Hazards: Hardware such as air conditioners, water heaters or fuse boxes shall be inaccessible to children. The playground shall be free of glass, debris, holes and other hazards.

Rule 19a-79-7a(g)(4) and/or 19a-79-7a(h).

Nonprescription Topical Medications: Labeling/Storage: Nonprescription Topical Medications shall be stored in the original container and shall be appropriately labeled and shall be stored away from food and inaccessible to children. Any unused portion of the medication shall be returned to the parent(s).

Rule 19a-79-9a(a)(3).